Background: Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.

Methods: 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.

Results: The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).

Conclusion: Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.

Fig1: Flow chart of the randomization procedure used to enroll patients in the study.

Mentions:
All patients were assessed for eligibility, while 16 patients were excluded, for whom did not meet the inclusion criteria (10 patients) or refused to participate (6 patients). 117 of the 134 patients completed the entire study (Figure 1). There were no significant differences in sex, age, BMI, time between the onset of symptoms and hospital admission, no significant difference was found in the preoperative serum levels of albumin, Hb, creatinine, and operative time, intra-operative blood loss, intra-operative transfusion, usage of supplemental albumin postoperation, preoperative preparation time the number of patients treated with metronidazole, penicillin, ceftriaxone, liver function (ALT and AST) (Table 1 for intention-to-treat and Additional file 1: Table S1 for per-protocol).Figure 1

Fig1: Flow chart of the randomization procedure used to enroll patients in the study.

Mentions:
All patients were assessed for eligibility, while 16 patients were excluded, for whom did not meet the inclusion criteria (10 patients) or refused to participate (6 patients). 117 of the 134 patients completed the entire study (Figure 1). There were no significant differences in sex, age, BMI, time between the onset of symptoms and hospital admission, no significant difference was found in the preoperative serum levels of albumin, Hb, creatinine, and operative time, intra-operative blood loss, intra-operative transfusion, usage of supplemental albumin postoperation, preoperative preparation time the number of patients treated with metronidazole, penicillin, ceftriaxone, liver function (ALT and AST) (Table 1 for intention-to-treat and Additional file 1: Table S1 for per-protocol).Figure 1

Bottom Line:
Postoperative outcome were recorded.And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway.

Background: Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM.

Methods: 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction.

Results: The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P < 0.001).

Conclusion: Perioperative probiotics treatment could reduce the serum zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery.